Methodology of the Study

This report is aimed at identifying the key factors affecting recruitment and retention of hospital nurses. While there is vast literature on the nursing shortage, relatively few studies provide rigorous correlations between hospital employment practices and RN vacancy or turnover rates. Moreover, when scholars conduct statistical analyses of employment policies, it is difficult to clearly distinguish the impact of a single policy within the broader context of hospital operations. No study has been done, for instance, that determines the exact amount by which retention rates will improve given a particular change in staffing ratios.

Despite the absence of such data, a wealth of research on both hospital employment practices and nurses' attitudes about their jobs makes it possible to identify the primary factors affecting recruitment and retention. This study's methodology starts with surveys of nurses to identify the key factors that account for nurses' dissatisfaction and to point to the most important changes that — in nurses' opinions — might entice those RNs who have dropped out of the profession to re-enter the hospital workforce. In addition to listening to nurses themselves, we also consulted surveys of hospital managers — CEOs, directors of nursing, and human resources directors — as well as the analyses of experts in the field. The study identifies key factors, in large part, as those that management, employees and experts all place at the heart of recruitment and retention dynamics.

After identifying the key factors affecting recruitment and retention, the study examines hospital employment practices that address these issues. We consider each of the major policies that has been promoted as a "best practice" and use a combination of economic data and employee and employer surveys to determine the extent to which a given practice resolves the problem it is intended to address. We use data from the magnet hospital studies — including a new survey of magnet hospitals undertaken by LERC staff in 2002 — to compare vacancy and turnover rates at "best practice" institutions with those at more typical hospitals.

In determining key factors and identifying best practices, we looked for consensus from multiple studies — from nurses, management or academics. Again, because of a shortage of data on best practices, we gave particular weight to those that emerged repeatedly, from a variety of independent studies. In places, the report may read repetitively for this reason: The goal is to clarify the strength of consensus in support of best practices by showing how multiple studies and organizations have reached the same conclusions.

Through this combination of survey data, economic analysis and case studies, the study constructs an extensive body of evidence that clearly identifies those hospital practices that are most likely to improve recruitment and retention of nurses. In addition, we pay special attention to the institution of mandatory overtime as a "worst practice." This analysis is based on the same evidence as the "best practice" models, combining economic analyses, comparative case studies, and employer and employee surveys to document the impact of what we have come to believe is a particularly harmful practice.

Finally, the study addresses the financial impact of adopting "best practices," examining profit margins at magnet hospitals to assess the extent to which "best practice" policies are economically feasible.

AFSCME is the American Federation of State, County and Municipal Employees, AFL-CIO. Our 1.6 million members provide the vital services that make America happen. AFSCME advocates for fairness in the workplace, excellence in public services and prosperity and opportunity for all working families.